Comparing Fall Risk in Older Adults on Full Agonist Opioids versus Buprenorphine Therapy

Background: Minimizing fall risk is an important tenet of geriatric medicine. Full agonist opioids have been demonstrated to escalate fall risk, and some data suggest buprenorphine, a partial opioid agonist, also increases fall risk. However, fall risk in patients with buprenorphine has not been directly compared with full agonist opioids or the partial agonist tramadol. Objective: DrugCompare the proportion of positive fall risk screenings among older adults in a primary care practice prescribed full agonist opioids or tramadol with those prescribed buprenorphine. Methods: Eligible patients were aged ≥ 65 years and had buprenorphine, tramadol, or full agonist opioid on their active medication list. Patient charts ranging from 2020 to 2024 were reviewed to compare fall risk screening scores. Data collected included opioid product(s), oral milligram morphine equivalents, fall risk screening result, kidney function, and use of other fall risk-increasing drugs. Of 240 patients who met inclusion criteria, 211 were taking full agonist opioids or tramadol, and 29 were taking buprenorphine. Results: Fall risk screening positivity did not differ significantly between groups (69% buprenorphine vs 58% other opioids; P = .179). An analysis of fall risk regardless of opioid product revealed a significant difference in positive screenings between female and male patients (65% vs 48%; P = .037) and patients aged <75 years vs those ≥ 75 years (52% vs 69%; P = .026). Conclusion: The proportion of positive fall risk screenings did not differ significantly between older adults taking buprenorphine versus full agonist opioids. Association between use of opioid products and fall risk among subpopulations warrants further investigation.